Anti-Anxiety Medication and Flying

Anti-anxiety medication to reduce flight anxiety backfires. The temporary — and generally inadequate — relief gained comes with a high long-term cost. Anti-anxiety medications prevent anxious fliers from getting used to flying. They increase the anxious flier's sensitivity to the plane’s noises and motions. They impact the person’s memory and ability to learn. They cause psychomotor impairment. And, they are addictive.

According to research at the Stanford University School of Medicine, though the person taking anti-anxiety medication may feel more relaxed psychologically, there is increased arousal physiologically. “Alprazolam increases physiological activation under acute stress conditions and hinders therapeutic effects of exposure in flying phobia.”

In this research study, 28 anxious fliers took two flights. On the first flight, half received alprazolam (generic Xanax) and half received a placebo.

Those taking alprazolam reported significantly reduced levels of anxiety compared with those taking a placebo during the first flight. However, their heart rate (114 bpm) and breathing rate (22.7 breaths/min) were much higher than in the group that had taken a placebo.

On a second flight a week later without medication, 71 percent of those who had taken alprazolam on the first flight had significantly increased anxiety, an increased heart rate (123 bpm), a desire to leave the plane, and panic. Commenting on this research in article in Clinical Psychiatry News, Shanna Treworgy, Psy.D., of the Dartmouth Geisel Medical School, said that though there may be reduced anxiety in the moment, benzodiazepines cause increased long-term anxiety reactions. This, she reported, has been "documented in both animal and human studies.”

An article in Clinical Psychiatry News says, "Widespread long-term use of benzodiazepines for anxiety remains a reality, despite guidelines that recommend against the practice.” Dominic Candido, who teaches psychiatry at the Dartmouth Geisel School of Medicine, says the use of benzodiazepines "significantly diminishes the effects" of treatment for anxiety. Short-term relief is, he says, "often at long-term detriment to the patient.”

Taken as prescribed, anti-anxiety medication do not adequately relieve flight anxiety. During flight, when the prescribed dose fails to provide relief, an anxious flier — perhaps in a state of panic — is likely to take more and, perhaps, to combine it with alcohol. Combining anti-anxiety medication with alcohol is unsafe. A news article about the excessive in-flight use of Xanax by actress Winona Ryder is at this link.

On the other hand, those who had taken a placebo on the first flight showed significant improvement. Having gained some degree of desensitization during the first flight, they now reported less anxiety.

In an New York Times article on flight phobia, psychiatrist Richard A. Friedman, M.D. wrote, "If you think you can outsmart your phobia with anti-anxiety medications like Valium and Klonopin, forget about it; they might numb you during an acute panic attack, but they will not erase your phobia. In fact, they could get in the way of therapy because they impede new learning, which is the essence of curing phobias. To kick a travel phobia, you have to fight fire with fire; you have to tolerate some anxiety to get rid of it. No shortcuts.”

As an infrequent flyer, Xanax has been a godsend. As someone who flies once a year at most, I don't have the luxury of repeat exposure as a means of overcoming extreme anxiety while flying. Every time I fly, it's as if it were the first time, and yes, I have found it is possible to be extremely anxious the entire 7 hour flight to Europe. For decades this crippled my ability to enjoy vacationing anywhere out of driving distance. I still did it, but but with gritted teeth and repeated panic attacks. It never got any better. I've used Xanax while flying over the last several years and it reduces my anxiety to a manageable level (e.g. no panic attacks.) Repeat exposure may work for those who can afford and have the time to fly frequently, but you'll pry my Xanax out of my cold, dead (or more likely, flushed and sweaty) hand as I make the long march down the concourse.

I always wanted to overcome my flight anxiety without the use of medication so it was what I tried first. I flew without anti-anxiety medication after months of therapy. I have flown successive flights without medication, I'd guess at least ten flights without meds. It was tolerable and I probably could do it again if I had to. But the reality is traveling without medication takes a lot of focus. I have two children who I always fly with, and even with my husband taking over complete care of them during flights it is nearly impossible to have them leave me completely alone (and I would hate to ask them to). On Xanax I am able to relax enough to interact with them. Secondly, I live in Hawaii, meaning every flight is a five hour minimum. Controlling my anxiety while in an anxiety producing situation for that long of a period of time is exhausting. Often I would start a vacation with a higher than normal level of anxiety which could take days to decrease, especially in new environments.
Since starting to take Xanax for flying, I find that I don't obsess about flights for weeks in advance and that I am much less stressed about the experience overall. I have less anxiety and panic while on vacation as well. In short I have had the complete opposite reaction of what this article states. Perhaps it is because I use the therapy I was taught along with the medication, as the article seems to insinuate that the medication alone won't work. Regardless, my quality of life would definitely be effected without Xanax for flying.